摘要
目的研究风湿关节炎(RA)合并肌少症(SA)患者血清25-羟维生素D3[25-(OH)D_(3)]、肌肉抑制素(MSTN)、四肢骨骼肌指数(ASMI)与骨质疏松(OP)发生的关系。方法244例RA患者作为病例组,123名健康体检者作为对照组,比较各组一般资料、血清25-(OH)D_(3)、MSTN水平、ASMI、外周血免疫细胞水平,并分析血清25-(OH)D_(3)、MSTN、ASMI对RA合并SA患者并发OP的诊断价值及血清25-(OH)D_(3)、MSTN水平、ASMI与外周血免疫细胞水平的相关性。结果病例组血清25-(OH)D_(3)、外周血调节型T淋巴细胞(Treg)细胞水平及ASMI低于对照组,血清MSTN、外周血辅助型T淋巴细胞17(Th17)细胞水平、Th17/Treg高于对照组(P<0.05)。244例RA患者中未发生SA 171例,发生SA 73例,SA发生率29.92%。SA组血清25-(OH)D_(3)、外周血Treg细胞水平及ASMI低于无SA组,血清MSTN、外周血Th17细胞水平、Th17/Treg高于无SA组(P<0.05)。OP组血清25-(OH)D_(3)、外周血Treg细胞水平及ASMI低于无OP组,血清MSTN、外周血Th17细胞水平、Th17/Treg高于无OP组(P<0.05)。血清25-(OH)D_(3)、MSTN水平及ASMI联合诊断RA合并SA患者并发OP的曲线下面积(AUC)高于三者单独检测(P<0.05)。RA合并SA患者及RA合并SA并发OP患者血清25-(OH)D_(3)水平、ASMI与外周血Th17细胞水平、Th17/Treg均呈负相关关系(P<0.05),与外周血Treg细胞水平均呈正相关(P<0.05);血清MSTN水平与外周血Th17细胞水平、Th17/Treg均呈正相关(P<0.05),与外周血Treg细胞水平均呈负相关(P<0.05)。结论RA合并SA患者OP发生率较高,同时SA和OP的发生可引起血清25-(OH)D_(3)、外周血Th17细胞水平、Th17/Treg及ASMI降低,血清MSTN、外周血Treg细胞水平升高,25-(OH)D_(3)、MSTN及ASMI联合检测可有效提高对RA合并SA患者并发OP的诊断效果,同时三者水平与外周血Th17细胞、Treg细胞水平、Th17/Treg明显相关。
Objective To study the relationship of serum 25-hydroxyvitamin D3[25-(OH)D_(3)],myostatin(MSTN),limb skeletal muscle index(ASMI)with osteopenia(OP)in patients with rheumatoid arthritis(RA)complicated with sarcopenia(SA).Methods A total of 244 RA patients selected as case group,and 123 healthy people who underwent physical examination in our hospital during the same period were selected as control group.The general data,serum levels of 25-(OH)D_(3),MSTN,ASMI and peripheral blood immune cells were compared among the two groups.The diagnostic value of serum 25-(OH)D_(3),MSTN and ASMI in RA patients with SA complicated with OP and the correlation between serum 25-(OH)D_(3),MSTN,ASMI and peripheral blood immune cells were analyzed.Results The levels of serum 25-(OH)D_(3),peripheral blood regulatory T lymphocyte(Treg)cells and ASMI in the case group were lower than those in the control group,while the levels of serum MSTN,peripheral blood helper T lymphocyte 17(Th17)cells and Th17/Treg were higher than those in the control group(P<0.05).Among the 244 RA patients,171 had no SA,73 had SA,and the incidence of SA was 29.92%.The levels of serum 25-(OH)D_(3),peripheral blood Treg cells and ASMI in the SA group were lower than those in the non-SA group,and the levels of serum MSTN,peripheral blood Th17 cells and Th17/Treg were higher than those in the non-SA group(P<0.05).The levels of serum 25-(OH)D_(3),peripheral blood Treg cells and ASMI in the OP group were lower than those in the non-OP group,while the levels of serum MSTN,peripheral blood Th17 cells and Th17/Treg were higher than those in the non-OP group(P<0.05).The area under the curve(AUC)of combined detection of serum 25-(OH)D_(3),MSTN and ASMI for the diagnosis of OP in RA patients with SA was higher than that of the three alone(P<0.05).Serum 25-(OH)D_(3)and ASMI in RA patients with SA complicated with or without OP were negatively correlated with peripheral blood Th17 cell level and Th17/Treg(P<0.05),and positively correlated with peripheral blood Treg cell level(P<0.05).The level of serum MSTN was positively correlated with the level of Th17 cells and Th17/Treg in peripheral blood(P<0.05),and negatively correlated with the level of Treg cells in peripheral blood(P<0.05).Conclusion The incidence of OP in RA patients with SA is high.At the same time,the occurrence of SA and OP can lead to the decrease of serum 25-(OH)D_(3),peripheral blood Th17 cell,Th17/Treg and ASMI,and the increase of serum MSTN and peripheral blood Treg cell.The combination detection of 25-(OH)D_(3),MSTN and ASMI can effectively improve the diagnosis of OP in RA patients with SA,and the levels of the three are significantly correlated with peripheral blood Th17 cells,Treg cells and Th17/Treg.
作者
施宏莹
洪文婷
洪志林
颜丽笙
SHI Hongying;HONG Wenting;HONG Zhilin;YAN Lisheng(Department of Rheumatology and Immunology,Fujian Medical University Second Affiliated Hospital,Quanzhou 362000,China;Inspection Department,Fujian Medical University Second Affiliated Hospital,Quanzhou 362000,China;Radiology Department,Fujian Medical University Second Affiliated Hospital,Quanzhou 362000,China)
出处
《免疫学杂志》
2025年第4期251-257,共7页
Immunological Journal
基金
福建省自然科学基金(2021J01279)。
